Mechanical thrombectomy with retrievable stents and aspiration catheters for acute ischaemic stroke: a meta-analysis of randomised controlled trials.
2021
Background: Retrievable stents and aspiration catheters have been developed to provide more effective
arterial recanalisation in acute ischaemic stroke.
Aims: The aim of this analysis was to test the effect of mechanical thrombectomy on mortality and longterm
neurological outcome in patients presenting with acute large-vessel anterior circulation ischaemic
stroke.
Methods: A structured search identified randomised controlled trials of thrombectomy (using a retrievable
stent or aspiration catheter) versus control on a background of medical therapy which included intravenous
thrombolysis if appropriate. The primary endpoint was disability at 90-day follow-up as assessed by the
modified Rankin scale (mRS). Secondary endpoints included all-cause mortality and symptomatic intracranial
haemorrhage. A Bayesian mixed-effects model was used for analysis.
Results: Twelve (12) trials met the inclusion criteria, comprising a total of 1,276 patients randomised to
thrombectomy and 1,282 patients to control. Randomisation to thrombectomy significantly reduced disability
at 90 days (OR 0.52, 95% credible interval 0.46 to 0.61, probability(control better)<0.0001). Furthermore,
thrombectomy reduced the odds of functional dependence at 90 days, indicated by an mRS score >2
(OR 0.44, CrI 0.37 to 0.52, pr<0.0001). Thrombectomy reduced all-cause mortality at 90 days (16.1% vs
19.2%, OR 0.81, 95% CrI 0.66 to 0.99, pr=0.024). The frequency of symptomatic intracranial haemorrhage
was similar between thrombectomy (4.2%) and control (4.0%) (OR 1.12, 95% CrI 0.76 to 1.68, pr=0.72).
Conclusions: In patients with an acute anterior circulation stroke, modern device thrombectomy significantly
reduces death and subsequent disability. The magnitude of these effects suggests that universal
access to this treatment strategy should be the standard of care.
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